| The Therapy Room

The Therapy Room: Hoarding

Posted on 19 July 2017 by LeslieM

By Julia Breur, Ph.D., LMFT

Hoarding disorder is defined by the Diagnostic Statistical Manual of Mental Disorders (DSM-5) as the persistent difficulty discarding or parting with possessions, regardless of their actual value.

Hoarding was considered a form of obsessive-compulsive disorder (OCD) until recently when the American Psychiatric Association recognized hoarding as its own disorder.

This disorder affects both males and females, but epidemiological studies report a significantly greater prevalence among males. This contrasts with clinical samples, which are predominantly female. Hoarding symptoms appear to be almost three times more prevalent in older adults, ages 55-94 years, compared with younger adults, ages 34-44 years.

Difficulty and distress comes into a hoarding individual’s world when there is a need to discard possessions or the accumulation of possessions that congest and clutter living areas and compromise their intended use. These individuals may not see their hoarding behavior and their collected items as a problem, making any treatment challenging. Hoarding is also known to cause depression, anxiety, anger and resentment among a hoarding individual’s family members.

Compulsive buying, the compulsive acquisition of free items and even the compulsive search for perfect or unique items is part of hoarding. Individuals with this disorder believe that an item will be useful or valuable in the future, has sentimental value, is unique and irreplaceable, or is too big a bargain to throw away. They may also consider an item a reminder that will jog their memory, thinking that, without it, they won’t remember an important person or event. Sometimes they can’t decide where something belongs and think it’s better just to keep it.

Hoarded items usually include paper products, such as newspapers, magazines, boxes and photographs, along with grocery items, food and clothing. Some individuals also hoard animals.

Hoarding is very different than collecting. In general, collectors have a sense of pride about their possessions and they experience joy in displaying and talking about them. They usually keep their collection organized, feel satisfaction when adding to it, and budget their time and money. Those who hoard usually experience embarrassment about their possessions and feel uncomfortable when others see them. They have clutter, often at the expense of livable space, feel sad or ashamed after acquiring additional items, and they are often in debt.

Many individuals live with broken appliances and without proper air ventilation and other living conditions of comfort. They cope with malfunctioning systems rather than allow a qualified person into their home to fix a problem.

Unlivable conditions that are a result of hoarding are known to lead to divorce, eviction, loss of child custody and serious financial issues.

A&E’s television show, Hoarders and TLC’s television series Hoarding: Buried Alive have brought this disorder into greater public awareness and discussion. Physicians, researchers and psychotherapists continue to develop new and effective hoarding treatment plans and with an active and flexible support system in place.

To assist in the recovery of a person who hoards, engage with care and compassion. Point out the risks and safety concerns, such as fire hazards, and slipping and falling potentials, versus accenting blame and shame. Develop a small step by small step strategy and, as key milestones are achieved, encourage and point out accomplishments being made. Many hoarding individuals have organizational challenges and you can help by enhancing concrete skills, such as use of a calendar, time management and setting goals. Hoarding information, resources and support for families, friends, spouses and the hoarding individual can be found at childrenofhoarders.org. Remember… change is possible.

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton, FL. For more information, visit www.drjuliabreur.com.

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The Therapy Room: Risks and rewards of online gaming

Posted on 15 June 2017 by LeslieM

Are you a “Gamer?” Someone who consistently spends time playing online video games on a personal computer (PC), console or a mobile device, such as a smartphone or tablet at least three to four times a week. Today, there are 2.2 billion gamers worldwide generating over $108.9 billion in revenue.

Playing online games over the Internet has become second nature. Millions of users enjoy playing with their family, friends and strangers competitively, and just for fun. The current on-board hardware of gaming consoles, PCs and other mobile devices can only offer certain levels of performance. The capabilities of cloud computing has the attention of gaming developers and gaming will see non-time sensitive processes, such as artificial intelligence taken on by cloud servers.

Many of my Psychotherapy patients, ranging in ages from 10 to 90 years, are gamers. Those with Autism Spectrum Disorder (ASD) experience positive interaction with peers and develop social skills playing a game called Minecraft. A CEO plays online games that involve strategy and skill while traveling on business. A freelance writer has joyfully confessed that she was a Pac-Man fanatic in the 1980s and continues playing Pac-Man online today. She told me she learned a life lesson playing Pac-Man, that you don’t always have to keep going or playing fast to meet goals, you can actually achieve great thing by stopping or being still. An accountant believes that if the time and energy put into gaming were applied to something worthwhile, positive results would be endless. There are numerous opinions, as well as risks and rewards, when it comes to online gaming. Let’s highlight a few:

Rewards:

Gaming allows you to interact online with other people and be social.

No need to disclose your identity (unless you want to); you can use a fictitious name.

Gamers have fun and experience good feelings about self and others while playing various online games.

Risks:

Absenteeism from work, school and other commitments can be high due to competing in and playing online games.

Relationships may suffer due to a partner’s invested time playing online games and interactions that develop with other gamers.

All ages play online games; a child might represent them self as an adult and an adult may present as a child.

There are dangerous “games” (For example, those introducing swallowing cinnamon, huffing and more).

Parents be aware of a game’s child safety measures and guidelines. Understand what single player and realms are and monitor your child’s online playtime.

Online gaming is here to stay! Rather than dismiss it, be curious and ask your children, and others, about their online gaming knowledge and experiences. Gaining new insight to others’ interests allows you to realize that within you … change is possible.

Dr. Julia Breur is a licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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THE THERAPY ROOM: ADHD or Attention-Deficit/Hyperactivity Disorder

Posted on 18 May 2017 by LeslieM

Have you noticed the new fidget widget toys being sold at retail and online stores? When played with, these toys help alleviate stressful behavior. Fidget widgets are popular with ADHD children and adults, but what exactly is ADHD?

Attention-Deficit/Hyperactivity Disorder is one of the most common neurobehavioral disorders of childhood and it has had numerous names, including “learning behavior disability” and “hyperactivity.” In 1987, the disorder’s name was refined to Attention-Deficit/Hyperactivity Disorder, or ADHD, and only recently have clinicians acknowledged that the symptoms of ADHD may continue into adulthood.

The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Inattention manifests behaviorally as wandering off tasks, lacking persistence, having difficulty maintaining focus and being disorganized but not due to defiance or lack of comprehension. Hyperactivity is excessive motor activity, excessive fidgeting, tapping or talkativeness. Impulsivity are hasty actions that occur in the moment without prior thought and have potential for harm to the individual, looking for immediate rewards, inability to delay gratification, social intrusiveness and even making fast decisions without considering potential consequences.

ADHD affects boys more than girls. The condition tends to run in families and no one knows how many adults continue to be affected by the remnants of this disorder. Alcoholism, divorce and other family disruptions are common markers associated with ADHD.

There is no single test to diagnose ADHD. Healthcare providers diagnose ADHD with the help of the standard guidelines from the American Academy of Pediatrics or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Also, a medical exam is usually recommended to include vision and hearing screenings.

Here are some tips for parents with a child diagnosed with ADHD:

Remain calm: a child’s anger will only escalate if a parent becomes angry. Diffuse, do not engage!

Help your child make good choices: During homework time, ask your child, “Do you want to do history or math first?” Driving in car ask, “What type of music should we listen to?” or “Should we turn the music off and talk about your school day?”

Do not take behavioral setbacks personally: All children make mistakes and it can be an opportunity for a parent to teach better choices, for example, saying, “We can do this better together.”

Be persistent: Never give up trying to help and teach your child; it may feel like you have explained better choices of behavior 50 times, but that 51st time might lead to signs of positive progress.

Focus on your child’s strengths and take notice of their interests: Your ADHD child may be our future U.S. president or a medical doctor, author, engineer, athlete, teacher, etc. Encourage and involve your child in what interests them. You may also learn a new thing or two along the way and always remember … change is possible!

Dr. Julia Breur is a Licensed Marriage and Family Therapist with a private clinical psychotherapy practice in Boca Raton. For more information, visit www.drjuliabreur.com.

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